April 16, 2025

Yesterday NYS lawmakers passed another budget extender (extender #5).  This permits the state to meet its financial obligations while SFY26 state budget negotiations continue.

Also yesterday Speaker Heastie told media outlets there is a framework agreement on language to address Discovery Reform, one of the issues holding up state budget enactment.  However the Governor repeatedly stated that negotiations on this issue are not over until she gets the language she needs and she is willing to extend negotiations into May to get the reforms she wants. Assuming this will resolve shortly, the focus will turn squarely on the outstanding budget controversy over Involuntary Commitment.  Here’s more from State of Politics this morning:https://nystateofpolitics.com/state-of-politics/new-york/politics/2025/04/15/after-discovery-battle–mental-health-debate-expected-to-take-budget-stage

And here’s more from Politico this morning:

“As budget negotiations drag on, mental health advocates and Democratic lawmakers are railing against Gov. Kathy Hochul’s proposal to expand on regulations for involuntary commitment. Instead, they are calling for the state to pass Daniel’s Law, address staffing shortages in the field, and bolster funding for outreach programs and stabilization centers.

State law limits involuntary treatment to occasions when a person is at substantial risk of physically harming themselves or others. Hochul’s proposal would also allow for its use when individuals are at risk of harming themselves if they can’t provide for their “essential needs such as food, clothing, medical care, safety, or shelter” due to a mental illness.

Assembly Speaker Carl Heastie said the issue is one of the remaining sticking points in three-way budget talks with Hochul and Majority Leader Andrea Stewart-Cousins. He told reporters on Tuesday that they are still working through a few minor issues, such as what happens to individuals after they complete treatment.

“I think there’s a couple of issues that the staff is trying to work out … like discharge plans, also when there’s a serious situation that needs to have the Office of Mental Health to really examine these things,” Heastie said. “It’s just smaller issues, I’d say, in the grand issues of involuntary commitment, I think that’s in a good place.”

Assembly Health Committee Chair Jo Anne Simon said the state needs to enact Daniel’s Law, which would ensure that a mental health professional responds to a person in crisis instead of a police officer. But she said even if they enact Daniel’s Law, that would not be enough. She said the state needs to invest in housing for individuals struggling with mental health issues or experiencing homelessness as part of the solution to the problem.”
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Improving flow of health records among providers

By David LombardoPublished On: April 15th, 2025

April 15, 2025 – Alexandra Fitz, head of the enterprise initiatives and partnership for the New York eHealth Collaborative, explains a statewide  effort to improve the flow of health care records among providers all over the state and public health officials.

Here’s a link to the interview:

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With all of the noise coming from Washington and the myopic focus by the Trump Administration and House Republicans in order to pay for the massive tax cuts they want to extend, Medicaid work requirement proposals seem to rise to the top of the list consistently.  Work Requirements are one of the most insidious strategies to cut Medicaid because they do so by triggering coverage losses rather than changing the structure of federal Medicaid financing. Coverage losses due to DOGE cuts that leave federal agencies without the infrastructure (people power!) they need to process incoming reports and documentation are a recipe for a disaster.

At the end of the day Work Requirements are a ‘menu item’ that have an impact at the front door (Americans being kicked off Medicaid rolls) and back door (inability to meet reporting requirements that results in loss of coverage).  And, for current Medicaid beneficiaries with disabilities that could qualify for an exemption, the process will still be incredibly difficult, putting millions of Amercians at risk.

Hundreds of thousands could lose coverage under Medicaid work requirement proposal

ETHAN GERINGER-SAMETH, Crain’s Health Pulse, 4/16/25\

Hundreds of thousands of New Yorkers could lose health coverage if Congressional Republicans move forward with a proposal to add work requirements under the Affordable Care Act’s Medicaid expansion.

Between 743,000 and 846,000 residents across the state could lose coverage next year if the plan – which was part of a 50-page list of potential cuts circulated by the House Budget Committee in January – is included in the budget reconciliation package, according to an analysis of census and Medicaid data by the Urban Institute, a Washington D.C.-based think tank. New York would be the second hardest hit state, after California, according to the analysis modeled on outcomes in states that have applied similar measures.

The cuts would amount to a collective loss of millions of dollars in coverage of some of the poorest New Yorkers, forcing more people to forgo emergency and preventative care. The outcome would likely be a strain on safety net hospitals, where many of the newly uninsured would seek care, often as a last resort, along with the state’s Medicaid coffers, experts say.

As part of the Affordable Care Act, states were incentivized to expand Medicaid to include adults ages 19 to 64, making up to 138% of the federal poverty level with no work requirements. Today, Medicaid covers close to half of the city’s 8.5 million residents.

Most people subject to work requirements are exempt either because they are working, looking for work, caregiving or have a physical or mental health issue that prevents them from working, according to the study. Though 9 out of 10 recipients aged 19 to 55 fall into that category many will likely lose coverage anyway because of low awareness, inability to navigate the compliance system and difficulties documenting cash employment, said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, which funded the Urban Institute study and a series of similar ones on other proposed cuts.

“The way that work requirements ‘save money’ is basically by mistakes, primarily,” Hempstead said.

The January list, first reported by Politico, says little about how the cuts would work, except that they would apply to “able-bodied adults without dependents” with exceptions made for pregnant women, primary caregivers, people with a disability that prevents them from work and full-time students. The measure would save an estimated $100 billion nationwide over ten years, according to the document.

The administrative burden of implementing the policy is significant and could cost tens of millions of dollars from the state’s Medicaid budget, said Cristina Freyre Batt, senior vice president of the Healthcare Association of New York State, a hospital trade group that opposes work requirements for Medicaid. The state will have to make that up either by raising taxes, reducing Medicaid coverage or lowering reimbursement rates to providers, she said.

“People will still need access to health care and they are going to seek it out…at a point that is going to be more costly for the system overall and worse for health outcomes,” she said. “We’re really looking for a solution to a problem that does not exist.”